Here's the short answer. Original Medicare covers a yearly "Wellness" visit at no cost to you, once every 12 months, if your provider accepts assignment. The Part B deductible doesn't apply. But the Wellness visit is not a routine physical exam. It's a conversation with your doctor to build or update a plan for preventing disease. Medicare does not cover a routine physical. If your provider does extra tests or services during the same visit that the preventive benefit doesn't cover, you may owe coinsurance and the deductible, and for something Medicare doesn't cover at all, like a routine physical exam, you may pay the full amount. That's the surprise bill.
What the yearly Wellness visit includes
The Wellness visit is a conversation-based visit with your doctor or another health care provider to create a personalized prevention plan based on your health and risk factors. You'll fill out a questionnaire called a Health Risk Assessment. During the visit, your provider will:
- Take routine measurements like height, weight, and blood pressure.
- Review your medical and family history and your current prescriptions.
- Give you health advice and a written plan, like a checklist, of the screenings, vaccines, and other preventive services you need.
- Do a cognitive assessment to look for signs of dementia. If there's a concern, Medicare covers a separate, more thorough visit.
- Check your risk for substance use disorder, and review your pain treatment if you take opioids.
- Offer to talk about advance directives.
- Order other tests if necessary, based on your health and history.
Notice what's not on that list: a hands-on head-to-toe exam. A Wellness visit can feel short, and that's by design.
What a routine physical is, and why Medicare doesn't pay for it
Medicare Part B pays for two kinds of doctor visits: medically necessary services to diagnose or treat a problem, and preventive services from Medicare's list. A routine physical exam, a general check-up with no specific problem to treat, is on neither list. Medicare's preventive list includes the "Welcome to Medicare" visit, the yearly Wellness visit, and specific screenings, vaccines, and counseling, but not a routine physical. That's why Medicare.gov gives "a routine physical exam" as its example of something you may have to pay for in full.
Many of the things people expect from a "physical" are covered, just under other names. Blood pressure and weight are part of the Wellness visit. Screening tests like mammograms, colon cancer screening, diabetes screening, bone density tests, and cardiovascular screening are separate preventive services, and you pay nothing for most of them if the provider accepts assignment. Our Part B guide covers what else Part B pays for.
The "Welcome to Medicare" visit
In your first 12 months with Part B, you can get a one-time "Welcome to Medicare" preventive visit. You pay nothing if your provider accepts assignment, and the Part B deductible doesn't apply. It's also not a comprehensive physical. It reviews your medical and social history, gives you information about screenings and vaccines, checks your risk for depression and substance use, calculates your body mass index, gives you a simple vision test, offers a talk about advance directives, and gives you a written prevention checklist.
Bring your medical and immunization records, your family health history, and a list of every prescription, over-the-counter drug, vitamin, and supplement you take. Your first yearly Wellness visit can't happen within 12 months of your Part B start date or of your Welcome visit. You don't have to have a Welcome visit to get Wellness visits later.
Three visits side by side
| Visit | How often | What it is | What you pay (Original Medicare) |
|---|---|---|---|
| "Welcome to Medicare" preventive visit | Once, in your first 12 months with Part B | History review, prevention checklist, BMI, simple vision test | Nothing if the provider accepts assignment; no deductible |
| Yearly "Wellness" visit | Once every 12 months | Conversation to build a prevention plan; routine measurements; cognitive check | Nothing if the provider accepts assignment; no deductible |
| Routine physical exam | Not a Medicare benefit | General head-to-toe check-up with no specific problem to treat | Possibly the full amount |
| Visit for a specific problem | As medically necessary | Diagnosis or treatment of a symptom or condition | 20% of the Medicare-approved amount after the Part B deductible |
The last two rows come from Medicare's rules for doctor services and preventive visits.
Why you got a bill
Most surprise bills after a "free" visit come from one of these:
- The visit was billed as a physical. If you asked for a "physical" or "annual exam" and the office did one, Medicare doesn't pay for it.
- Extra services during the same visit. You mentioned knee pain, the doctor examined and treated it, and that part became a separate, medically necessary service. You owe 20% after the deductible for that part.
- Tests Medicare doesn't cover, or covers less often. Your doctor may recommend a test Medicare doesn't cover or won't cover again so soon. Medicare.gov suggests asking why it's recommended and what Medicare will actually pay.
- The provider doesn't accept assignment. The $0 price for preventive services depends on the provider accepting assignment. Our Part B guide explains assignment and excess charges.
- Timing. A Wellness visit less than 12 months after the last one isn't covered as a preventive visit.
If a bill looks wrong, compare it with your Medicare Summary Notice and ask the office how the visit was coded. You can appeal a Medicare payment decision. See How Do I…? for reading an explanation of benefits, and common Medicare mistakes for other avoidable costs.
How to avoid a surprise bill next time
- Book it by name. Ask for the "Medicare yearly Wellness visit," not a physical or annual exam.
- Check the calendar. Make sure 12 months have passed since your last Wellness visit or your Welcome visit.
- Confirm the provider accepts assignment. That's what makes the visit $0.
- Ask before extras. If the doctor suggests a test or exam beyond the visit, ask whether Medicare covers it and whether you'll be billed.
- Book problems separately. Bring up new symptoms at a separate appointment. You'll still owe cost-sharing for that visit, but you'll expect it.
- In Medicare Advantage, ask the plan. Plans set their own extra benefits and cost-sharing. Some cover a routine physical; check your plan documents. See Medicare Advantage.
Common questions
Is the yearly Wellness visit a physical?
No. Medicare.gov says plainly that it "isn't a routine physical exam." It's a conversation-based visit to create or update a prevention plan, with routine measurements like blood pressure and weight, but not a hands-on head-to-toe exam.
Does Medicare pay for an annual physical at all?
Original Medicare doesn't. A routine physical isn't on Medicare's list of preventive services, and Medicare.gov uses it as the example of something you may pay for in full. Some Medicare Advantage plans include one as an extra benefit. Ask your plan.
I got a bill for lab work done at my Wellness visit. Is that right?
It can be. The Wellness visit itself is $0, but tests or services during the same visit that aren't part of the preventive benefit can carry coinsurance and the deductible. Many screening tests are covered at no cost on their own schedule, so ask the office how each test was billed.
Do I need the "Welcome to Medicare" visit before a Wellness visit?
No. You can go straight to yearly Wellness visits. But your first Wellness visit can't be within 12 months of your Part B start date or of a Welcome visit.
Can I have the Wellness visit and a problem visit on the same day?
Yes, but expect to pay for the problem part. The Wellness visit stays $0; the medically necessary part is billed like any other doctor visit, usually 20% after the Part B deductible. Medicare suggests a separate appointment so the Wellness visit stays focused on prevention.
Official sources
- Medicare.gov: Yearly "Wellness" visits
- Medicare.gov: "Welcome to Medicare" preventive visit
- Medicare.gov: Preventive & screening services
- Medicare.gov: Doctor & other health care provider services